Overview

Melatonin has been proven to be of some value in treating cluster headaches. For some, melatonin is enough to prevent or turn off an episode of clusters. Twenty-seven articles in medical journals mention melatonin and cluster headaches; most of these indicate that it can be of benefit.

In the most promising study on melatonin and clusters, Leone did a double-study and found that half of the patients receiving melatonin responded in a few days; their headaches became less frequent and then ceased. When they stopped melatonin, the headaches returned. None of the patients receiving placebo showed any improvement. (abstract (cache)) Although a 50% response rate is far from perfect, Leone noted that melatonin may be better tolerated than other preventive medicines.

While Leone concluded that melatonin was only beneficial for those with episodic CH, Perez and Rozen found that melatonin did help 2 patients with chronic CH. (abstract (cache))

Melatonin is produced in the body and is a pacemaker hormone that helps regulate circadian cycles. People with cluster headaches have disrupted melatonin production. The total amount produced is lower than normal, the peak or surge of melatonin at night is not as well defined as it should be, and the timing of the peak is off.

Naagtegal reported that melatonin was beneficial for those suffering from delayed sleep phase syndrome; he concluded melatonin supplements helped one such person with episodic clusters, as well as people with other types of headache that co-occured with delayed sleep phase syndrome. (abstract (cache)) Nicotine causes phase advance in circadian cycles, which may be related to the fact that a large proportion of people with cluster headache use tobacco products.

In moderate doses, melatonin does not change the structure of sleep; it does not increase the amount of time spent in REM or any other stage of sleep. PMID:15459246 (cache) In higher doses (>5 mg), it may increase the amount of time spent in REM. PMID:9406038 (cache) As most clusterheads have low levels of melatonin production, a small to moderate supplement probably has a normalizing effect on sleep.

Melatonin is useful for Insomnia. A recent study at MIT found that a very low dose (0.3 mg) was better than the standard 3 mg dose. (text (cache))

Dosage

For some people, a dose of as little as 1 milligram is enough to restore circadian rhythms and prevent cluster headaches. Others have seen no benefits of such small doses, but did respond to much larger doses (9-12 milligrams or more). As with most CH therapies, some people do not respond at all.

In the United States, 3 mg tablets are the most common product on the market, although there are some products containing as little as .25 mg (250 micrograms).

Regular, Time-Released, or Sublingual?

There is no clear evidence that any of the three common formulations of melatonin are superior to the others in terms of preventing cluster headache. Sublingual (liquid placed under the tongue) is absorbed more rapidly and efficiently, but ordinary tablets can be effective. Time released melatonin may better simulate the natural patterns of melatonin release, although it is not clear if that has any effect on preventing headaches.


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Timing

Melatonin should be taken at the same time each night, shortly before bed.

It has been suggested that it is easier to prevent a cycle with melatonin than to interupt one that is in full swing. Some episodics notice Warning Signs (prodromal symptoms) before a cycle begins, and this may be the best time to begin melatonin.

Toxicity

It is widely said that melatonin is non-toxic. This is true in one sense - it is almost impossible to overdose lab animals on melatonin and kill them. Melatonin does not poison the liver, kidneys, or other organs (in fact, it is a powerful anti-oxidant that may protect them). Melatonin will not paralyze the breathing and cause suffocation like alcohol and narcotics can.

But melatonin does have the potential to disrupt the body, and aggravate some existing conditons. Concerns have been raised about the effects of large doses of melatonin on people with depression, asthma, and autoimmune diseases like rheumatoid arthritis and multiple sclerosis. source (cache)

On the other hand, melatonin supplementation has been shown to improve mood in menopausal and perimenopausal women. See Abstract (cache)

The most common side effect of melatonin is drowsiness or difficulty awakening. Many people also report more vivid dreams; studies have shown that melatonin does not increase the amount of time spent sleeping, but it does increase dream recall.

The PDR entry on Melatonin (cache) lists precautions in pregnant and nursing women, children, those with epilepsy or siezures, depression, and anyone operating dangerous machinery.

A number of studies on animals have shown that large doses of melatonin can impair fertility. Some caution that melatonin may do the same in people, but this has not been demonstrated. In many species, females go into heat only once or twice per year; there is a clear mating season that is determined by daylength. Male fertility in many animal species is also linked to the calendar. Humans, on the other hand, are fertile through out the year. While it is possible that melatonin might disrupt various clocks and calendars in humans, it seems that these are already malfunctioning in clusterheads, and a regular melatonin regime could be beneficial.

Natural Strategies to Raise Melatonin Levels

• Get sunshine in the morning and mid-day
• Avoid light at night - light interupts melatonin production
• Meditation can raise melatonin production
• Stimulants Can Lower Melatonin Production
  • Avoid Caffeine in the late afternoon and evening
  • Beware of pseudoephedrine and other OTC stimulants
• Keep a regular sleep schedule
• Excercise
• Tryptophan or 5-HTP

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